Following the money behind the same old formula

As if busy new parents having to choose a formula milk product for their baby haven’t got more important things to do than trying to fathom what’s going on with the trans-Tasman standards on baby formula – the interests involved, the lobbying, the Government opting out of the trans-Tasman formula standards then backtracking and considering rejoining.

At stake here is the nutritional and developmental health of babies. As a consultant neonatologist at Starship Hospital in Auckland and a researcher who primarily focuses on early life development of the immune response, I would hope the interests of our children’s health couldn’t be so easily hijacked by financial interests. I’d hope parents could be provided with unbiased information so they could follow the science of what to feed their child, rather than be dazzled by unfounded marketing claims.

The trans-Tasman rules on baby formula aimed to achieve this, developed by Food Standards Australia New Zealand over more than a decade to update 20-year-old regulations. Among many other things, it tightens rules on misleading claims and ensures families have the right support when they need to use “medical” formula milk products.

New Zealand initially opted out, citing potential harm to its $2 billion annual infant formula exports. An RNZ investigation revealed extensive lobbying by a handful of formula companies, which met Government officials to persuade them the changes would hit their exports and profits, and their future in New Zealand.

According to RNZ, the companies, led by Danone and a2, sent senior ministers emails, letters, surveys and even legal advice, as well as having at least six meetings with Food Safety Minister Andrew Hoggard in the six months leading up to the decision late last year.

The companies objected to the plan to restrict “medical” formula sales to pharmacies, and opposed changes that would have prevented them from being able to promote ingredients or milk protein fractions on the front labels of formula tins, the latter being key to their current marketing practices. This week it was announced that the companies now support opting in to the regulations.

The formula industry is very competitive and hugely profit driven, so marketing (deploying the powers of persuasion, rather than providing objective information) is a key driver of profitability. New parents are particularly vulnerable to persuasion; they will always want to give the best available product to their child – even if this comes at a higher cost.

When I need to feed babies with formula at Starship, I wouldn’t have a clue which brand of baby formula they’re being fed, and it wouldn’t matter if I did. The ingredients in baby formula are so highly regulated that all standard formulas are essentially the same and meet strict requirements. If I’m asked which formula new parents should feed their babies, I’d tell them the one that best suits their budget; even the cheapest standard formula milk meets a baby’s nutritional needs.

Unsubstantiated claims of health benefits include supporting brain development or strengthening immunity – who wouldn’t want their children to be smarter or have fewer infections? However, a study in 2023 published in the British Medical Journal showed that most products did not provide scientific references to support claims, and even when they did, these were not supported by robust clinical trial evidence.

To what extent is it ethical to build your marketing strategy on exploiting that parental instinct to do the best for their child? Where do you draw the line between acceptable and unacceptable practices? Often, families who need to use formula are struggling financially, so what are the ethics of putting the global financial interests of companies over the interests of new parents?

This is particularly sad to see in a country with poor breastfeeding rates and no national network of milk banks, as do other progressive countries.

If the Government prioritised the health of Kiwi babies, it would invest more in breastfeeding support in hospital and community settings. It would develop a national network of milk banks to support human milk donation. But of course, these would work against the financial interests of the formula industry.

I would expect any progressive government to prioritise the provision of health services and best practice in healthcare over industry interests.

On a more general level, the Government’s vulnerability to the persuasions of industry players and their ignorance of scientific evidence and expert advice sends a message that their policy making isn’t evidence-based either. This may be a global trend, but it is not something the scientific community or the public should accept.

Breastfeeding will always be superior to any formula, as we will never be able to fully replicate a highly dynamic biofluid, always personalised to the actual needs of the baby. There is a place for formula in society, although there is a lot more to uncover about the short- and long-term health implications of formula feeding in comparison with breastfeeding.

The formula industry should invest more into this crucial area of research. Eventually, this would also help establish the scientific basis of the claims about their products.